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Central Aortic Cannulation for Stanford Type A Aortic Dissection with the Use of Three‐Dimensional and Two‐Dimensional Transesophageal Echocardiography
Author(s) -
Brinster Derek R.,
Parrish Dan W.,
Meyers Kenneth Sadler,
Reddy Pingle,
Kasirajan Vigneshwar
Publication year - 2014
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.12411
Subject(s) - medicine , aortic dissection , cardiopulmonary bypass , aortic arch , surgery , cardiac surgery , complication , dissection (medical) , anesthesia , aortic cross clamp , aorta , circulatory system , cardiology
Background There is still significant disagreement among surgeons about the best method for arterial cannulation to institute cardiopulmonary bypass (CPB) in patients with acute type A aortic dissection (STAADs). This study aimed to provide support for central aortic cannulation as a viable and preferable option, as it reduces time to institute CPB, operative times, and decreases the complexity of the procedure. Methods This study is a retrospective review of 34 patients who underwent STAAD repairs consecutively between October 2006 and January 2014. The sample was analyzed for method of cannulation, CPB time, cross‐clamp time, circulatory arrest time, mortality, and complication rate. Statistical analysis was performed to compare a control group of patients who underwent nonaortic cannulation. Results The most common method of cannulation was the distal aortic arch, which also produced the lowest relative mortality. The 30‐day mortality was found to be 17.6%. Arrhythmia, acute renal injury, and failure to extubate within 48 hours were the most frequent complications, and cerebrovascular accidents occurred in three patients (8.8%). Statistically significant differences in bypass and cardiac arrest times favored aortic cannulation. Conclusions This study supports the notion that central aortic cannulation is a viable option for CPB in STAAD repair, but further prospective, randomized trials are necessary for the procedure to replace peripheral cannulation techniques. doi: 10.1111/jocs.12411 (J Card Surg 2014;29:729–732)